Developed lower back pain when running
2009
Question
I had always been very active but developed lower back pain when running in 2001. I had various tests which proved negative and so I modified my exercise regime but, by 2005, the pain had spread to my buttocks and hips. I could hear cracking if I squeezed my buttocks together. I have seen chiropractors, osteopaths and done core stability strengthening as suggested by them. In 2007 I fell from a ladder but amazingly broke nothing.
In February of this year, my GP thought it wouldn't be a bad idea to have an MRI of the areas where the cracking noise occurred as my back between my shoulder blades was getting quite painful, like being pierced through with a spear with discomfort to the front of the rib cage. He referred me to a spinal surgeon but, to my astonishment, it would seem not too bad apart from a couple of schmorl's nodes.
This has slowly been getting worse, now going under both shoulder blades and, at times, up to the right hand side of the neck. It can also be felt in the sternum at the front which the surgeon said can happen as the ribs are connected all the way round at that height. It has recently developed something akin to a crushing feeling and is now beginning to feel like it’s giving me a tickly cough. It feels like a hand grasped round the middle of the spine and it doesn’t like twisting round movements. It can be uncomfortable to get to sleep but mornings aren’t quite so bad, as the day goes on it worsens.
My GP has prescribed pain killers and I have also been referred for Spect scans but am concerned about their safety.
My current situation is that the lower back seems to have got rather worse in the last 2-3 months. The upper back, in the areas aforementioned, has also got worse. It is also rather unstable, I think, as that has peculiar noises and occasional movement emanating from it now. I think a lot of the pain and discomfort from that is due to the muscles in that area becoming locked into a near constant spasm, biased towards the right side. It is all rather depressing. Driving can also, on occasions, be painful with pain on what I presume are probably the lowest of facet joints at right and left.
So I suppose what I need to know is there any other way of finding placement for facet joint injections, such as ultrasound (or indeed CT, but that of course is x-ray based again and I don’t know what radiation it gives out) and what might be the chance of success, if it is indeed the way to go? I have heard that nerves can be destroyed by heat and that the needle is placed by ultrasound? Is that a possibility?
Would or should it be possible to have the bone gap made larger for the compromised nerve roots in the lower back and what might be the success of that? Or is it best to try to soldier on until such time one may be almost immobile and try the above surgeries then? As far as I know, these could be last resort options anyway, not to mention risky.
Or may it even be that, as I have read in some of your replies to letters in Talkback, scar tissue may over time form round these areas and lead to a reduction in pain and an improvement in stability? However long that time frame maybe, I am only just 4I and had always been very active, but I suppose age is no barrier to muscoskeletal problems. I have and continue to try my best to fight this but am in painful discomfort everyday, along with thousands of others I suppose. Might I have a favourable outlook or am I going to continue in a downward spiral?
Mr N G S – Bucks
Answer
Having read all Mr S’s documentation, the essential points are:
- Low back pain suggestive of facet joint arthritic pain for around seven years, supported by MRI findings in February 2006, and tending to worsen slowly since in spite of a variety of treatments.
- Thoracic pain radiating around the chest to the front at times since a fall from a ladder in December 2007. MRI of February 2008 normal. Some temporary improvement from massage and moderate exercise which seems to hold things in check.
- Notices a variety of clicks and cracks in the spine and shoulders and back with feelings of instability.
- Facet joint injections suggested as a next step but worried about irradiation.
Advice
We have a reasonable working diagnosis as outlined above. However I would advise a repeat ESR as the previous blood specimen was clotted and the ESR can reveal a rheumatic tendency or polymyalgia which requires specific treatment. The arthritic or wear and tear change in the small pairs of joints in the low back cannot be reversed but its effects are usually controllable by moderate stretching and strengthening exercises with simple or anti-inflammatory painkillers as necessary. The evidence in favour of glocosamine is not strong.
Nerve pressure in the low back does not seem to be a problem as leg pain is rarely felt. The clicks and cracks tend to be symptomatic of muscle spasm and tension secondary to joint pain or injury and need stretching and strengthening activity. Avoid sitting in one position for long periods and check arm-chairs and car seat, etc for comfort. Gadgets such as rockers and rollers can be helpful in some individuals but try them on approval first!
Facet joint injections can be very helpful as can Spect scanning. I would not worry about irradiation as I am told that modern x-ray machines are highly efficient and use low doses of radiation. I would certainly consider such treatment as the next step.
In the longer term it will be a matter of Mr S managing his back according to the most effective treatments for him, we are all different! There is no reason why his level of symptoms should increase even though the wear and tear changes may progress slowly. Nature is remarkably clever at compensating for long-standing conditions.
We wish him well and hope he will report progress.
Alan Gardner FRCS
Consultant in Spinal Disorders (Rtd)